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Please return this portion with your dues payable
to |
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| Terrebonne Historical & Cultural Society MEMBERSHIP |
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| ____ Individual $20 | Organization: | ____ Organization $35 |
| ____ Family $35 (best value for 2 people) |
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| ____ Contributing $50 | Business: | ____ Corporate $100 |
| ____ Donor $100 | ____ Supporting $250 | |
| ____ Supporting | ____ Benefactor $500 | |
| Total Enclosed $_______________ | ||
| Is this a ____ New Membership? ____ Renewal? _____ Gift Membership? | ||
| Member Name(s): _________________________________________________ |
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| Mailing Address: __________________________________________________ |
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| Gift from (please list name & address): ________________________________ |
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Thank you for your support. |
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